arthritis Flashcards
1
Q
osteoarthritis risk factors
A
- > 50
- women
- obese
- genetics
- occupation
- sport injury
- joint hypermobility syndrome
2
Q
osteoarthritis pathophysiology
A
- primary degenerative condition of mainly weight bearing joints that is associated with breakdown of articular cartilage as a result of mechanical stress and an imbalance of the inflammatory mediators involved in the repair process
- degenerating joint is unable to produce cartilage and instead replaces the lost cartilage with bone, which reduces the joint’s ability to cope with mechanical stress and creates a cycle of joint degeneration
- wear and tear of the joint
3
Q
osteoarthritis presentation
A
- slow onset, asymmetrical and localised joint pain that’s worse on activity and at the end of the day, and is relieved by rest
- morning stiffness of < 30 minutes and inactivity gelling
- most commonly affected joints are hip, knee, cervical spine, DIP (Heberden’s nodes) and PIP (Bouchard’s nodes and thumbing squaring)
- hard bony joint with crepitus and reduced range of movement
4
Q
osteoarthritis diagnosis
A
x-ray showing loss of joint space, osteophytes, subchondral sclerosis and subchondral cysts
5
Q
osteoarthritis lifestyle management
A
- weight loss
- exercise
- physiotherapy
- walking aids
6
Q
osteoarthritis medication and surgical management
A
- analgesia (paracetamol and topical NSAIDs)
- cheilectomy
- arthroplasty
arthrodesis - joint replacement
7
Q
rheumatoid arthritis is most common in
A
- women > men
- any age group, especially in 30-50 years old
8
Q
rheumatoid arthritis causes
A
- HLA-DR4 mediated (exact cause unknown)
- triggers include smoking, infection and stress
- severity is linked with presence of HLA-DR4 and autoantibodies
9
Q
rheumatoid arthritis pathophysiology
A
- autoimmune condition associated with symmetrical polyarthritis of primarily peripheral joints and chronic systemic inflammation
- damage to joint is caused by inflammation and expansion of the synovial membrane
- cartilage and bone are damaged by inflammation and by the synovium forming a pannus, which invades and breaks down the articular cartilage
- mainly affects synovium
10
Q
rheumatoid arthritis presentation
A
- most commonly affects small joints of hands and feet (PIP not DIP), wrist, ankle, elbow and cervical spine
- quick onset of symmetrical, swollen, painful and stiff joints
- pain that is worse in the evening, better with activity and worse with rest
- morning stiffness is substantial, lasts for a few hours and wears off with movement
- joint subluxation (cervical spine)
- ulnar deviation of fingers
- swan neck, boutonniere and Z thumb deformities
- rheumatoid nodules
- fatigue, malaise, shortness of breath
- hot, soft, swollen joints that are tender to squeeze and have an associated reduced range of movement
11
Q
rheumatoid arthritis extra-articular features
A
- lung/elbow nodules
- lung fibrosis in the lower lobes
- bronchiectasis, interstitial lung disease, pulmonary fibrosis, pleural effusions, lung nodules, Caplan syndrome and pleurisy
- vasculitis
- scleritis and episcleritis
- keratoconjunctivitis sicca
- pericarditis
- carpal tunnel
- Raynaud’s
- osteoporosis
- neutropenia
12
Q
what is Felty’s syndrome
A
rheumatoid arthritis with splenomegaly and neutropenia
13
Q
rheumatoid arthritis diagnosis
A
- x-ray showing loss of joint space, erosions, soft tissue swelling and soft bones
- serology with anti-CCP and rheumatoid factor
14
Q
rheumatoid arthritis management
A
- start DMAD (methotrexate and short course of steroids) and NSAIDs
- hydroxychloroquine for palindromic disease (attacks come and go)
- steroids used for remission induction in flares or as a filler while other drugs start to work (IM steroids for acute flare)
- only give biologics after failure of two different DMARDs, chest x-ray and co-prescribed with methotrexate
- women of child bearing age should be given contraceptive and advised to stop methotrexate for at least 3 months before conception
- IM methylprednisolone for acute flares
15
Q
rheumatoid arthritis surgical management
A
- synovectomy
- joint replacement
- joint excision
- tendon transfers
- arthrodesis
- cervical spine stabilisation
